Driessen Johanna H M, van den Bergh Joop P W, van Onzenoort Hein A W, Henry Ronald M A, Leufkens Hubert G M, de Vries Frank
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands.
Diabetes Obes Metab. 2017 Mar;19(3):421-428. doi: 10.1111/dom.12843. Epub 2017 Jan 19.
To investigate the association between long-term dipeptidyl peptidase-4 (DPP-4) inhibitor use and risk of fracture among people with type 2 diabetes mellitus (T2DM).
A retrospective population-based cohort study, using data from the Clinical Practice Research Datalink database (2007-2015), was conducted. All those (N = 328 254) with at least one prescription for a non-insulin antidiabetic drug (NIAD), aged ≥18 years at the time of data collection, were included. Cox proportional hazards models were used to estimate the hazard ratios of any fracture, osteoporotic fracture and hip fracture in DPP-4 inhibitor users compared with those using other NIADs. Analyses were stratified by continuous duration of DPP-4 inhibitor use. Time-dependent adjustments were made for age, sex, lifestyle, comorbidity and concomitant drug use.
Current use of DPP-4 inhibitors was not associated with risk of any fracture (adjusted hazard ratio [HR] 0.99 [95% confidence interval {CI} 0.93-1.06]) as compared with current other NIAD use. Current use of DPP-4 inhibitors was also not associated with risk of osteoporotic or hip fracture. After stratification by continuous duration of DPP-4 inhibitor use the highest category was not associated with any (>4.0-8.5 years of use, adjusted HR 0.99 [95% CI 0.70-1.41]), osteoporotic (>3.0-8.5 years of use, adjusted HR 0.75 [95% CI 0.52-1.09]) or hip (>2.0-8.5 years of use; adjusted HR 1.24 [95% CI 0.85-1.79]) fracture.
Continuous long-term DPP-4 inhibitor use (defined as >4.0-8.5 years of DPP-4 inhibitor use for any fracture, >3.0-8.5 years for osteoporotic fracture and >2.0-8.5 years for hip fracture was not associated with risk of any, osteoporotic or hip fracture. These findings may be of value for clinical decisions regarding treatment of patients with T2DM, especially those at high risk of fracture.
研究2型糖尿病（T2DM）患者长期使用二肽基肽酶-4（DPP-4）抑制剂与骨折风险之间的关联。
采用基于人群的回顾性队列研究，使用临床实践研究数据链数据库（2007 - 2015年）的数据。纳入所有在数据收集时年龄≥18岁且至少有一张非胰岛素抗糖尿病药物（NIAD）处方的患者（N = 328254）。使用Cox比例风险模型估计DPP-4抑制剂使用者与使用其他NIADs者相比发生任何骨折、骨质疏松性骨折和髋部骨折的风险比。分析按DPP-4抑制剂的连续使用时间分层。对年龄、性别、生活方式、合并症和同时使用的药物进行时间依赖性调整。
与当前使用其他NIADs相比，当前使用DPP-4抑制剂与任何骨折风险无关（调整后风险比[HR] 0.99 [95%置信区间{CI} 0.93 - 1.06]）。当前使用DPP-4抑制剂也与骨质疏松性骨折或髋部骨折风险无关。按DPP-4抑制剂的连续使用时间分层后，使用时间最长的类别与任何骨折（使用>4.0 - 8.5年，调整后HR 0.99 [95% CI 0.70 - 1.41]）、骨质疏松性骨折（使用>3.0 - 8.5年，调整后HR 0.75 [95% CI 0.52 - 1.09]）或髋部骨折（使用>2.0 - 8.5年；调整后HR 1.24 [95% CI 0.85 - 1.79]）均无关。
持续长期使用DPP-4抑制剂（定义为使用DPP-4抑制剂>4.0 - 8.5年发生任何骨折、>3.0 - 8.5年发生骨质疏松性骨折、>2.0 - 8.5年发生髋部骨折）与任何骨折、骨质疏松性骨折或髋部骨折风险无关。这些发现可能对T2DM患者尤其是骨折高危患者的治疗临床决策具有价值。
